Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud.
In these podcasts, you get to listen in on my conversations with some really amazing people. You will hear what health literacy is, why it matters and ways all of us can help improve health understanding.
Today, I’m talking with Gary Schwitzer who has published www.HealthNewsReview.org since 2006.
He is an adjunct Associate Professor in the University of Minnesota’s School of Public Health and Director of the Center for Media Communication and Health. Previously, he directed a health journalism graduate program.
Gary has been working with and in the media for many years. No surprise, he has received numerous awards for his many contributions to medical communication.
I first met Gary when he spoke at an NIH program for journalists called Medicine in the Media. I subscribe to HealthNewsReview and have been his fan ever since.
Welcome to Health Literacy Out Loud.
Gary Schwitzer: It’s great to join you, Helen. You know I love to speak about these things, so it’s nice to have the opportunity in this new and different forum.
Helen Osborne: It’s great because our listeners are people all involved with some aspect of health communication, be it as clinical folks, public health, teachers or educators. We all care a lot about communicating our message clearly, effectively and accurately.
Your work is looking at all of that health news out there and finding the ways those messages perhaps aren’t being communicated as clearly as they might.
Can you just introduce all of the listeners to what HealthNewsReview is?
Gary Schwitzer: Originally, it was our bread and butter, which we continue with, but now we have expanded this focus. The original bread and butter was to look at healthcare news stories that included claims about interventions and news stories done by leading news organizations across the country.
In order to grade them, analyze them and try to improve the health journalism, and therefore improve the public dialog about the topics that were covered in these stories, we applied 10 standardized criteria.
Helen Osborne: Can I ask you to clarify, Gary? You’re not just talking about what I might refer to as kind of that “snake oil “salesperson talk about the things that we know as hype and not at all able to be accurate. Are you talking about regular stories we might see on the morning news show and open our newspaper and read too?
Gary Schwitzer: Absolutely. There’s The New York Times, The Wall Street Journal and USA Today, leading news organizations with veteran journalists who are rolling out of bed every morning and trying to do their best and yet are under time-driven pressures.
Economic pressures within newsrooms these days mean that the people don’t have all of the time and resources they used to have.
This is not a media-bashing effort. This is meant to be outreach to help people do a better job.
Helen Osborne: You’re looking at those articles that all of us are reading and the way that so many of the general public gets health information. You talked about the criteria. What kind of criteria do you use to do this? It’s not just saying, “We like this article or we don’t.”
Gary Schwitzer: That’s right.
Helen Osborne: You have a standardized way of looking at that, correct?
Gary Schwitzer: Yes. There are 10 that we apply to all these stories. I’m not going to run through all 10, but I’ll tell you five of them because they also happen to be the five that arguably are the most important, and we know from our data that they are the five that get the poorest grades and performance over time.
If it’s a story that makes a claim about something, did it adequately discuss cost? Did it adequately quantify the potential benefits and harms? Did it evaluate the quality of the evidence? In reporting about the new, did it put the new into the context of existing alternatives?
In one sweeping comment, I’ll tell you that between two-thirds and 70% of stories get unsatisfactory grades on those five very important things.
Helen Osborne: Wow. Cost, benefits, harms, evidence and alternatives. You read an article and you hear, “Go get this screening test,” “Go get this exam,” or, “Go do this or that.” That’s not being addressed adequately in those news stories.
Gary Schwitzer: In a nutshell, I think that we often are whipping the worried well into a frenzy over things that are still preliminary many times, that are not ready for prime time and, in the attempt to report on the new, we just don’t deliver the nuance.
Helen Osborne: I like that, the new with the nuance.
Gary Schwitzer: I also want to say quickly, Helen, because I told you I would get to this, that we’re not only now reviewing news stories but we’re now reviewing healthcare-related news releases from government agencies, medical journals, medical centers and from drug and device manufacturers.
Increasingly, we’re looking not just at news, but at PR and also at advertising and marketing, which we touch on on our blog site.
Helen Osborne: That’s really interesting. The scope has widened much more. I’m assuming that the majority of our listeners are probably practitioners. They’re probably not journalists and certainly not on a big, national scale.
We’re the ones who are maybe meeting with folks who are saying, “I saw on TV that I needed to do this, that or the next thing.” What can we do to help the people we care for and care about understand health news more clearly?
Gary Schwitzer: I think there are a couple of very simple tenets that can help anyone who communicates at any level with patients or the public about healthcare interventions, things like in healthcare more is not always better. It may seem counterintuitive, but less can be more in healthcare.
When you’re talking about an intervention, if all you ever hear about are the potential benefits, I would say run for the hills because a complete discussion has to include a discussion of potential harms. There are tradeoffs involved in any intervention.
One of the topical areas where we see this played out the most is an incomplete discussion of screening test issues.
Helen Osborne: When I first met you, we were talking about screening tests, and that was years ago. That keeps coming up.
Just to clarify for listeners who might be worldwide, when you say screening tests, how do you define that term? It’s kind of an odd use of the word screen, I think.
Gary Schwitzer: In general, Helen, from a health literacy perspective, I think that our public understanding of and discussion on screening tests is abysmal, so your question is a good starting point.
We confuse screening tests with diagnostic tests. The way I try to explain it to an audience is that a screening is like going into a football stadium of 60,000 people about whom you know very little or nothing, but you’re going to look for problems in all of them. That’s throwing this wide net of screening.
A diagnostic test is where we know enough about you and we know that there are signs or symptoms that would warrant us to look further. We have a reason to look further or do a follow-up.
That’s really important because you can see that the screening test is a broad population message, which on the other hand comes down to be a very important individual decision. That’s where a lot of the confusion comes in.
Helen Osborne: I really appreciate that distinction between the two because they do get muddied up a lot. That term “screening test” almost sounds like insider jargon, and why should the public need to know that?
When we thinking of screening tests, I guess some common ones are mammograms and PSA screening.
Gary Schwitzer: Blood cholesterol and, increasingly now, things like genetic tests are becoming more widely promoted in a direct-to-consumer, direct-to-patient manner.
Helen Osborne: Can you give us an example? What is a problem out there that we should pay more attention to?
Gary Schwitzer: First of all, I want to be really clear that nothing I’m about to say can be or should be construed as anti-screening. I’m not a physician. I’m a long-time journalist. What I’m about to tell you is informed largely by what a really smart doc once told me when I was producing a patient-decision aid on a screening test issue.
I remember he said, “We should never tell anyone not to be screened just as we should never tell anyone to be screened. It’s our job to explain the evidence, what good might come out of it and what bad may come out of it, and let people plug in their own values to the decision.”
Whether it is prostate cancer screening, breast cancer screening or cholesterol testing, it is a mindset that should lead you to think before you roll up your sleeve for the PSA blood test or cholesterol test or before you go in for the mammogram.
Think, “What good might come out of this, but what are the downstream harms that I need to think about now before I go into this?”
There’s a great quote that Sir Muir Gray, who is a physician in the U.K., once wrote. He said, “All screening tests cause harm. Some may do good as well.”
Helen Osborne: Oh, that’s interesting.
Gary Schwitzer: I could say that’s the reverse of what we usually talk about, but actually that’s not even true because we don’t come anywhere close to discussing even the reverse of that. We generally do not talk about harms of screening tests.
Helen Osborne: I want to put this in a practical sense. This makes sense to me. I certainly have had those tests and have gotten a variety of different results, and I’ve had to deal with the fallout from some of those.
You’re talking about talking with a clinician or somebody about the harms and what happens downstream, but the media message might be, “Go get your mammogram. One in eight women will whatever.” That’s a quick, easy out-there message, and especially when some famous person detected something awful through the mammogram.
How do we counter that in a very real, practical way?
Gary Schwitzer: I think that you, at some point, not only have to try to improve health literacy on these issues, but health numeracy. We need to talk about the fact that false positives will occur from any test.
I think it can help many people, but not everyone to think, “How often do false positives occur? How often do false negatives occur? How often do we find something that men or women like me might think after the fact, ‘I found something I wish I didn’t even know about’?”
Doctors call them incidentalomas. They’re things we incidentally discover that we almost wish we didn’t know about because they cause anxiety.
Helen Osborne: We all have stuff wrong with us.
Gary Schwitzer: Anxiety is a very real harm. Let me tell you that in media messages and I think in the public dialog, anxiety over false positives is often downplayed and almost ridiculed.
I would chasten anyone not to downplay the reality of false positives unless you’ve talked with a bunch of people who’ve experienced them. I have. Patients I’ve interviewed over time say that anxiety from screening tests is real.
There was one interesting paper in the Annals of Family Medicine a while back that looked at false positives and psychosocial consequences after a screening mammography. It suggested in a nutshell that anxiety from false alarms may affect women for at least three years.
Helen Osborne: Oh my goodness.
Gary Schwitzer: This cannot be downplayed.
Helen Osborne: Gary, do you know of any examples of someone doing this well? We all want to learn. Do we all need to kind of figure out for ourselves how to communicate these nuanced aspects of what’s new?
Gary Schwitzer: In fact, you and this NIH Medicine in the Media workshop where we met, we undoubtedly encountered together a couple of the leading voices in this country. Several of them happened to be at Dartmouth Medical School, such as Dr. Steve Woloshin and Lisa Schwartz.
Helen Osborne: I have a podcast. I have some articles with them. I’ll put them on your Health Literacy Out Loud web page. They’re terrific.
Gary Schwitzer: There’s also Gill Welch. There’s Barry Kramer at the National Cancer Institute and Russell Harris at North Carolina Chapel Hill. I could go on and on, and this is a good thing.
There is an increasingly strong group of people who are working very hard to try to improve this public dialog because it’s a realization that we simply must.
Helen, if we don’t improve the public dialog about screening tests, I don’t think we stand a chance of improving the public dialog about downstream treatment issues.
In other words, if we lead people to think that there are only benefits, that there are no harms and that we ought to be screening everybody of every age for everything, then we will find so many things that we will have created a mindset that they all must be treated as well.
If you’re not going to do something about them, why would you look?
Helen Osborne: That’s right. That’s affecting our entire healthcare system, the costs and how much of our lives are focused on illness versus just leading healthy lives.
Gary, when you listed those folks who are doing great work, I want to add you to that list too. You have been an ongoing advocate for really looking at our health messages and making sure they are up to snuff, you might say.
Can you please share with everyone the URL for your website? You also have a great weekly blog. I look forward to it every week.
Gary Schwitzer: Thank you. It’s very simple. It’s just www.HealthNewsReview.org. I believed in having a name like Toys ‘R Us. You know what they do. We do health news reviews, so it’s www.HealthNewsReview.org.
Helen Osborne: Thanks. I really love that.
You’ve been looking a lot and finding all the things we’re not doing well. There is a growing movement of people who are communicating health messages well. But I can imagine that it can be overwhelming and frustrating to just keep picking apart articles and saying, “They didn’t get it right.”
I want to reframe this. You’ve been doing this for a long time. What keeps you excited about what you’re doing?
Gary Schwitzer: The fire really does burn in me. I’m very passionate about these topics, and I could not continue to do it if I didn’t see reason for optimism.
Both in media messages and on the science and research end where we’ve already touched on why there’s reason for optimism, I’ve seen enough examples, only anecdotes so I can’t give you a sweeping systematic measurement, of media messengers.
They’re mostly journalists who are getting the message, who are improving and who I think are really leaders in their news organizations in trying to both tell the news, but educate and help people at the same time.
Nobody in journalism rolls out of bed in the morning, puts their pants on and says, “How can I go in and hurt people today?” The harm that we do with inaccurate, imbalanced and incomplete messages about healthcare, although unintentional, is still very real.
In healthcare, there are three terms that I now start to apply to media as well. We want to avoid avoidable ignorance, avoidable harm and avoidable healthcare where it’s not necessary. I think communicators at any level can help people avoid those pitfalls as well.
Helen Osborne: Thank you, Gary. Your optimism is contagious. I encourage listeners to go forth, communicate your message the way you really want it understood.
Thank you, Gary, so much for being a guest on Health Literacy Out Loud.
Gary Schwitzer: Thank you for the chance. Come to our website. I think you’ll learn a lot from it.
Helen Osborne: Thanks.
As we just learned from Gary Schweitzer, it’s so important to get health messages correct, but doing so isn’t always easy. It can be hard to clearly communicate health messages. For help, please contact me or visit my health literacy consulting website at www.HealthLiteracy.com.
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Until next time, I’m Helen Osborne.